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General NPI Number Information
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NPI Number | 1316276868
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Entity Type | Organization
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Legal Business Name | NEW YORK VEIN CENTER
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Dates
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Enumeration Date | 12/11/2009
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | 2989 OCEAN PKWY
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City | BROOKLYN
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State | NY
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Zip | 11235-8386
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Country | US
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Telephone | 718-996-4400
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Fax | 718-449-3807
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Provider Business Mailing Address
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Address Line | 2989 OCEAN PARKWAY
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City | BROOKLYN
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State | NY
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Zip | 11235
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Country | US
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Telephone | 718-996-4400
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Fax | 718-449-3807
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Authorized Official
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Title or Position | OWNER
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Name | DAVID M GLASS
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Credential | M.D.
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Telephone | 718-996-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 139939
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License Number State | NY
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